When Mickey's mom learned that he would be discharged from the Eisenhower Center, she was frantic.
by Jan Schlain
From the July, 2021 issue
Mickey, forty-two, is one of more than 6,600 Michigan residents receiving long-term care and rehab after auto accidents. At seventeen, in White Lake north of Detroit, "he was walking down a dark road and was hit by a car and was left in a ditch for dead," his brother Nate recalls. (Nate asked that their family name not be used.) "He ended up in a coma for three months.
"During the accident, he shattered his pelvis, suffered a TBI [traumatic brain injury], and a number of other health issues," Nate continues. Mickey has lived in specialized TBI-care facilities ever since.
Because of his brain injury, Mickey "has some behavioral issues and some impulse control issues," Nate says. "He's in a wheelchair 24/7. He can't communicate verbally ... He had gone through a number of other facilities" before he was admitted to Eisenhower.
The Ann Arbor center was "like the promised land for him," Nate says. "Eisenhower has the ability to manage him, and he's made progress at that facility in the last twenty-plus years." But in mid-May, they learned that they had one month to find him another place.
Mickey is one of "sixteen to twenty" patients who got discharge letters in May, Eisenhower CEO John Cornack says. "And that number is going to go higher," he warns. "It's not going to go lower." Like Mickey, he says, many Eisenhower patients are receiving care paid for by auto insurers--and on July 1, those payments will fall 45 percent.
Until 2019, Michigan's no-fault insurance law required all drivers to purchase unlimited "personal injury protection" for post-accident care. High "PIP" rates had made Michigan's insurance rates some of the highest in the nation--but also made possible places like Eisenhower, which Cornack calls "probably the best center in the country" for patients like Mickey.
To cut costs, in 2019 the legislature allowed residents to choose much lower PIP coverage or even forego it altogether. Those who studied it closely understood that
by doing so, they were giving up the possibility of ever getting care at a place like Eisenhower. Almost no one understood that the changes would also curtail care for existing patients like Mickey.
"It's completely contrary to what my mom understood was the law," Nate says. "There was supposed to be an entire class of people who were grandfathered in ... they were supposed to continue receiving care at the level they were receiving it...
"How do you change a law like this and take away that protection and say: good luck with your TBI son? To me, that strikes me as just wrong."
"Patients are grandfathered in, sure--but at 55 percent" of the current rate, Cornack says. "They're grandfathered in to nothing. There won't be caregivers for them at 55 percent ... if we can't care for someone by our ethical standards, we have to send that letter" discharging them.
Cornack fought the 2019 changes, and he's still fighting. Eisenhower's discharge letters urged families "to share your concerns and frustration with this legislative change with those who can fix the issue. An amendment to the law that would provide a reasonable fee schedule for providers like Eisenhower Center was proposed months ago," but house and senate leaders "have denied the bills the opportunity for hearings and votes." In June, Cornack and some of his residents joined 200-300 wheelchair-using accident victims in a protest at the state capitol.
The reimbursement cuts also hit companies that provide home care. Musicians Andrew Kratzat and Alicia Doudna suffered TBIs and other devastating injuries in 2011, when their Honda Civic was crushed between two semis on I-94. Doudna recovered enough to return to performing and teaching, but Kratzat still needs a lot of support.
A settlement from the trucking company enabled him to buy a handicap-adapted house, but ongoing care is paid from a state insurance fund. "No-fault is the reason I'm alive and as well off as I am," he told the Observer in 2018. Now, his mother Janet Kratzat emails, "his care company may find that they can no longer support no fault clients."
"I have no idea what will happen after July 1st," Kratzat emails. "This is what I wish our lawmakers understood. I'm trying to be optimistic about my recovery, but the 'not knowing what will happen' is very draining."
Kratzat says his providers are hopeful that a new bill introduced in June has a better chance of passage. But staff at the office of House minority leader Donna Lasinski say they have "no idea" whether it will be taken up before the legislature's extended summer break.
Cornack believes that "the powers that be have decided, 'It's OK--we can just wait and let it end and then see what happens.'"
He says that Eisenhower isn't closing, and can still care adequately for some no-fault patients. "We can work with the adjusters, we can work with the insurance industry--we can negotiate rates we can live with." But he says that the most severely injured residents require staffing that's simply not sustainable at the new rates.
"We're hoping that our legislators will make the right decisions about what a fee schedule should look like to care for these people," he says. "If it doesn't happen, they will all have to go down the same path--which is living on the streets, living in skilled nursing homes, living in jail, living in psych wards."
He says they'll do all they can to prevent that: "We will plan and work and make sure everything is as safe and good as we can make it." After Mickey's mother asked them to delay his discharge, he was given a one-month extension.
But his family is still searching for that safe and good place. Eisenhower suggested four other centers that might accept him, but he'd already been in and out of two of them. A place near their mother in Genesee County seemed promising, Nate says, but Mickey "requires twenty-four-hour staffing, which apparently they don't support." As the Observer went to press, they were down to a facility in Grand Rapids, though "putting him on the other side of the state is essentially excluding him from our family.
"We're still trying to find a facility that will accept him," Nate emails, "but at least we have until mid-July."
[Originally published in July, 2021.]
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